Yusuke Matsuura

MRI findings including gadolinium-enhanced dynamic studies of malignant, mixed mesodermal tumors of the uterus: differentiation from endometrial carcinomas

Abstract. Our objective was to evaluate the usefulness of MRI including dynamic study in differentiating malignant, mixed mesodermal tumor (MMMT) from endometrial carcinoma (EC). The MR images were reviewed in 4 patients with histologically confirmed MMMT and 11 patients with EC. Flow voids inside and/or around the tumors were seen in 2 patients with MMMT but not in any EC cases. In dynamic studies, all 4 patients with MMMT showed areas of early and persistent marked enhancement similar to that of the myometrium, mixed with areas of gradual and delayed marked enhancement. The portions showing early and persistent enhancement histologically corresponded to predominantly sarcomatous components with prominent vascularity. Ten of 11 ECs did not show such enhancement and only one showed a rapid enhancement in the early phase which was diminished in the delayed phase. The MR imaging with a gadolinium-enhanced dynamic study seems to be useful in differentiating MMMT from EC.

Early cervical neoplasia confirmed by conization : Diagnostic accuracy of cytology, colposcopy and punch biopsy

OBJECTIVE To investigate the accuracy rates of cytology, colposcopy and punch biopsy in early cervical neoplasia confirmed by conization. STUDY DESIGN During the 10 years from 1984 to 1993, cold knife conization was performed on 151 patients with early cervical neoplasia proven by punch biopsy at our department. The accuracy rates of cytology, colposcopy and punch biopsy were investigated. RESULTS The accuracy rates of cytology, colposcopy and punch biopsy were 52% (78 of 151), 66% (100 of 151) and 66% (100 of 151), respectively. CONCLUSION These results suggest that a composite diagnosis with cytology, colposcopy and punch biopsy is necessary for a correct evaluation. Early cervical neoplasms are frequently seen in young women, and conservative procedures, such as conization, cryosurgery and laser vaporization, are the treatments of choice in order to preserve reproductive function. We recommend conization as the best conservative procedure, with preservation of reproductive function.

Cytologic Analysis of Primary Stomach Adenocarcinoma Metastatic to the Uterine Cervix

OBJECTIVE To investigate the cytologic and pathologic features of endocervical lesions in cases of gastric adenocarcinoma metastatic to the uterine cervix. STUDY DESIGN From 1986 to 1994, four patients with gastric adenocarcinoma metastatic to the uterine cervix were treated at our department. The cervical cytologic samples were obtained by swabbing and were stained by the Papanicolaou method. Presence of tumor diathesis, number of atypical cells, cell arrangement, cytoplastic vacuoles, cellular and nuclear diameter, chromatin distribution and size of the nucleolus were investigated. RESULTS The smear backgrounds were dirty (tumor diathesis) in two cases and clean in two. No significant difference in the number of atypical cells or in cell or nuclear diameter between primary and metastatic adenocarcinoma was shown. Cell arrangement was the different cytologic finding between primary and metastatic adenocarcinoma. Sheetlike or isolated arrangement was seen frequently in metastatic cervical adenocarcinoma. CONCLUSION Because different cytologic features have been found in past and the present series, cytologic diagnosis of metastatic cervical adenocarcinoma should be made carefully.

Low Grade Cervical Intraepithelial Neoplasia Associated with Human Papillomavirus Infection

OBJECTIVE To investigate the correlation between the development of low grade cervical intraepithelial neoplasia (LCIN) and human papillomavirus (HPV) infection in cases with long-term follow-up. STUDY DESIGN Forty-three cases of LCIN were followed for more than five years with cytology, colposcopy and Vira Pap. Coexistence of HPV infection was sought using a simplified HPV detection kit, the Vira Pap method (Dot Blot hybridization). RESULTS Regressive disease was noted in 21 cases, and persistent and progressive disease was noted in 22 cases. HPV DNA was negative in 81% (17 of 21) of regressive disease and positive in 55% (12 of 22) persistent and progressive disease. LCIN had disappeared in 17 (63%) of 27 cases negative for HPV DNA and was persistent or progressive in 12 (75%) of 16 cases positive for HPV DNA. CONCLUSION The clinical course of LCIN correlates well with HPV infection.

Sarcoma botryoides of the cervix : Report of a case with cytopathologic findings

BACKGROUND Cytologic findings of sarcoma botryoides were still equivocal because sarcoma botryoides of the uterine cervix is an extremely rare neoplasm, and few cases have been reported to date. CASE A 17-year-old female was diagnosed with sarcoma botryoides of the uterine cervix. The entire vaginal canal was occupied with polypoid masses, which arose from the anterior lip of the uterine cervix, and the tumor was classified as group I (Intergroup Rhabdomyosarcoma Study). After wedge resection and six courses of combination chemotherapy, the tumor recurred in the same location of the cervix as the primary lesion. Touch smear of the polypoid mass formed loose clusters and also showed short spindle cells in a necrotic background. The nucleus of the tumor cells had a thin nuclear membrane, fine chromatin pattern and partly clear nucleolus, showing mild nuclear atypia. Immunohistochemically, some of the tumor cells showed positive staining for myoglobin and desmin. CONCLUSION The cytologic findings of sarcoma botryoides of the female genital tract are typical features of nonepithelial malignant tumor. Immunohistochemical study is useful for the diagnosis of rhabdomyosarcoma.

Placental site trophoblastic tumor: Immunohistochemical and nuclear DNA study

A rare case of placentae site trophoblastic tumor (PSTT) studied by immunohistochemistry and nuclear DNA analysis is reported. The patient, a 24-year-old Japanese female, complained of amenorrhea. Dilatation and curettage revealed a small specimen that contained trophoblastic cells and caused intractable bleeding. Pelvic sonography revealed a 5-cm mass in the posterior uterine wall with multiple cystic lesions of several sizes. The cystic lesions were shown to be dilated vessels by magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). Serum beta-hCG (beta subunit of human chorionic gonadotropin) was 3.7 ng/ml. Total abdominal hysterectomy revealed a well-circumscribed, yellow, soft mass in the posterior uterine wall. Microscopic findings were consistent with PSTT and the mitotic count was extremely low. Immunohistochemically, most of the tumor cells were intensely stained with human placental lactogen, whereas few were stained with human chorionic gonadotropin. The nuclear DNA content of the trophoblastic cells showed a sharp peak at the triploid range coexistent with a few cells of higher ploidy. This is the first report of sonographic findings and nuclear DNA analysis by spot cytometry in a case of PSTT.

Glassy cell carcinoma of the uterine cervix: combination chemotherapy with paclitaxel and carboplatin in recurrent tumor.

Combination chemotherapy with paclitaxel and carboplatin every 4 weeks for 3 cycles was administered for recurrent glassy cell carcinoma of the uterine cervix in a 67‐year‐old Japanese female. The response rate was 56% under computed tomography (partial response). However, the effect was transient even with follow‐up radiotherapy, and further cases need to be accumulated to determine a successful treatment modality.

Expression of estrogen receptor-α as a prognostic factor in patients with uterine serous carcinoma.

Objectives Although the expression of estrogen receptor (ER) is usually found in uterine endometrioid adenocarcinomas, it has recently been reported to be found in some uterine serous carcinomas (USCs). This report describes the clinicopathologic features of USC with an expression of ER-&agr;, with special reference to the prognostic significance of ER-&agr;. Methods The immunohistochemical expression of ER-&agr; was examined in 33 USCs. Greater than 10% staining was defined as an overexpression of ER-&agr;. Cox univariate and multivariate analyses for USCs were performed. Results A total of 7 USCs (21.2%) exhibited an expression of ER-&agr;. All tumors were pure-type USCs and strongly demonstrated an overexpression of p53. The cancer-specific 5-year survival rates of patients with USC without an expression of ER-&agr; and USC with an expression of ER-&agr; were 54.5% and 0.0%, respectively (P = 0.04). The univariate analyses showed an expression of ER-&agr; to be a significant prognostic indicator in patients with USC (P < 0.05). However, multivariate analyses for USCs showed that the surgical stage was an independent prognostic factor, whereas the significance of ER immunoreactivity disappeared. Conclusions Uterine serous carcinoma with an expression of ER-&agr; was associated with advanced-staged tumors and a significantly worse prognosis than that without an expression of ER-&agr;. When an endometrial biopsy specimen reveals USC with an expression of ER-&agr; and an overexpression of p53, the presence of an extrauterine lesion is suggested.

Prognostic significance of overexpression of p53 in uterine endometrioid adenocarcinomas with an analysis of nuclear grade

Although overexpression of p53 is usually found in uterine serous carcinoma (USC), it is also found in some uterine endometrioid adenocarcinomas (UEA). This report describes the clinicopathological features of the UEA with overexpression of p53 with special reference to a prognostic significance of nuclear grade.

Cellular characteristics of Arias-Stella reaction in ectopic pregnancy. Immunocytochemical studies with epithelial membrane antigen and vimentin

OBJECTIVE Endometrial cytology in nine cases of ectopic pregnancy was examined in order to elucidate the cellular characteristics of the Arias-Stella reaction and decidual change. STUDY DESIGN The cellular findings of epithelial and stromal cells were compared with histologic findings in each case. Furthermore, the immunocytochemical reactivity of each type of cell cluster-epithelial cells without atypia, epithelial cells with atypia, deep stromal cells and sheetlike stromal cells-to epithelial membrane antigen (EMA) or vimentin was investigated and compared with cytologic findings in smears stained with Papanicolaou stain. RESULTS The distribution of each type of cell cluster correlated fairly well with the histologic findings on the endometrium. Immunocytochemical examination revealed that EMA expression coincided with cell origin identified by Papanicolaou stain. Epithelial cells with atypia, probably corresponding to the Arias-Stella reaction, frequently showed positive reactivity to antivimentin antibody as well as anti-EMA antibody. Endometrial stromal cells usually indicated negative reactivity to anti-EMA antibody. Deep stromal cells expressed vimentin, but sheetlike stromal cells, thought to be decidual cells, infrequently expressed vimentin. CONCLUSION The Arias-Stella reaction may be the result of the regenerating and proliferating activity of endometrial glands. It is still controversial whether sheet-like stromal cells are identical to decidual cells.